Frontiers in Cardiovascular Medicine最新文献

{"title":"Editorial: Exploring the impact of inflammatory processes on the course of acute myocardial infarction: pathways and therapies.","authors":"Manan Pareek, Tarek Bekfani, Mihaela Popescu","doi":"10.3389/fcvm.2026.2001946","DOIUrl":"https://doi.org/10.3389/fcvm.2026.2001946","url":null,"abstract":"","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"2001946"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149230981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-enabled deep clinical phenotyping in heart failure with preserved ejection fraction: from patient subtypes to precision care.","authors":"Francisco Epelde","doi":"10.3389/fcvm.2026.1956165","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1956165","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome defined by shared manifestations but produced by diverse combinations of cardiometabolic, vascular, inflammatory, renal, pulmonary, atrial, skeletal-muscle, and aging-related mechanisms. This heterogeneity limits the value of classifications based only on left ventricular ejection fraction and helps explain why many mechanistically plausible interventions have produced neutral average results. Deep phenotyping can move the field from descriptive heterogeneity toward biologically coherent and clinically actionable subtypes by integrating clinical trajectories, advanced imaging, exercise and invasive hemodynamics, circulating biomarkers, multiomics, and digital physiology. Artificial intelligence (AI) offers methods to combine these high-dimensional data, but statistical clusters should not be equated with disease endotypes. A useful subtype must be reproducible across cohorts, anchored to plausible biology, associated with a distinct clinical course, and able to improve diagnosis, therapeutic selection, or clinical-trial design. This Review examines the translational continuum from experimental HFpEF models to human patient subtypes, summarizes the main deep-phenotyping domains and AI approaches, and proposes seven clinically interpretable subtype families: cardiometabolic-inflammatory, hypertensive-vascular aging, atrial myopathy, pulmonary vascular-right ventricular, cardiorenal-congestive, peripheral-frailty, and specific etiologic phenocopies. Current evidence supports a layered treatment strategy in which broadly effective therapies, particularly sodium-glucose cotransporter 2 inhibitors, are combined with phenotype-directed management of obesity, diabetes, mineralocorticoid receptor activation, atrial fibrillation, congestion, pulmonary vascular disease, and physical deconditioning. The central next step is prospective validation of dynamic subtype assignments in external populations and phenotype-enriched trials. Phenogroup labels should therefore be regarded as pragmatic, transitional proxies for dominant mechanisms when those mechanisms cannot yet be measured directly at the individual-patient level; their value lies in improving decisions while the field moves toward fully individualized mechanism-based treatment. Deep phenotyping will be clinically valuable only when it changes a decision and improves an outcome, rather than merely increasing descriptive complexity.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1956165"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial appendage morphology and hemodynamics: potential new markers for individualized thromboembolic risk assessment in atrial fibrillation.","authors":"Bingxin Liu, Xianyong Liu, Changlin Zhang, Henan Zhao","doi":"10.3389/fcvm.2026.1924120","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1924120","url":null,"abstract":"<p><strong>Background: </strong>Traditional CHA₂DS₂-VASc scoring has well-recognized limitations in thromboembolic risk assessment for atrial fibrillation (AF), particularly in low-score patients who nevertheless thrombose, high-score event-free individuals, cancer patients, and post-ablation cohorts. The left atrial appendage (LAA) is the source of 98% of thrombi in non-valvular AF and exhibits marked inter-individual morphological and hemodynamic variability that traditional scores completely ignore.</p><p><strong>Aims: </strong>This narrative review critically evaluates current evidence on LAA morphology, hemodynamics, computational fluid dynamics/fluid-structure interaction (CFD/FSI) studies, and digital twin technology, and proposes a mechanism-driven, individualized risk assessment framework for AF-related thromboembolism.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed/MEDLINE and Web of Science (1990-May 2026) using combinations of keywords related to LAA morphology, hemodynamics, AF, and thromboembolism. Priority was given to landmark original studies, high-quality observational studies with multivariable adjustment, meta-analyses, and contemporary CFD/digital twin studies. A narrative synthesis was adopted owing to heterogeneity in study designs and outcomes.</p><p><strong>Results: </strong>LAA morphological subtypes are associated with long-term stroke risk, with chicken-wing being protective (OR 0.21, 95% CI 0.05-0.91) and cauliflower carrying the highest risk (OR 8.02, 95% CI 0.92-27.86). However, risk is highly context-dependent, with chicken-wing unexpectedly increasing peri-ablation thromboembolic risk (OR 7.2, 95% CI 1.35-38.33) and windsock morphology independently predicting post-ablation AF recurrence (OR 2.72, 95% CI 1.21-6.12). Importantly, traditional morphological classification does not correlate directly with blood stasis (<i>p</i> = 0.365), whereas quantitative geometric parameters such as trabecular number, normalized stroke volume, and ostial area are far more sensitive predictors (R² = 74%). Digital twins integrating multimodal clinical, morphological, and hemodynamic data identify a high-risk phenogroup with a 70% thrombus history rate.</p><p><strong>Conclusion: </strong>Based on these findings, we propose a practical two-tier assessment framework combining basic morphological classification with multimodal refined evaluation (digital twin) for intermediate-/high-risk or clinically challenging cases. This framework represents a paradigm shift from static clinical scores toward mechanism-driven, individualized risk management. Prospective validation of this approach is now warranted.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1924120"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ubiquitination regulation in coronary microcirculation dysfunction: focus on the endothelial cells.","authors":"Qingying Zhang, Tingting Wang, Siyu Wang, Yushan Chen, Yiwen Sheng, Haodi Zhang, Yunhao Wang, Boyuan Jin, Chengjun Hua, Xinyi Han","doi":"10.3389/fcvm.2026.1952434","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1952434","url":null,"abstract":"<p><p>Basic and clinical research on coronary microvascular disease (CMD) has spanned half a century. As a pathogenesis independent of epicardial coronary stenosis, CMD has become a major hotspot in cardiovascular medicine. Ubiquitination, a vital post-translational modification in eukaryotic cells, precisely regulates target proteins via the E1-E2-E3 enzymatic cascade and plays a critical role in cardiovascular homeostasis and pathophysiology. Recent evidence indicates that the ubiquitin-proteasome system (UPS) is deeply involved in the development of CMD by modulating nitric oxide production, barrier function, and inflammatory signaling in coronary microvascular endothelial cells. This review summarizes recent advances in ubiquitination, elaborates its molecular mechanisms in regulating coronary microcirculation, and dissects its pathogenic roles in diabetes, hypertension, and myocardial ischemia/reperfusion injury (MIRI).We further discuss potential therapeutic strategies and translational challenges of targeting the ubiquitination pathway for CMD, including proteasome inhibitors, E3 ligase modulators, deubiquitinase agonists, and PROTACs, aiming to provide new insights for future research.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1952434"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Plasma ALKBH5 depletion during severe intermittent hypoxia and its attenuation by galectin-3 inhibition: an experimental rat study.","authors":"Saad Al-Anazi, Yasser A Alshawakir, Syed Shahid Habib, Hayam Gad, Asma F Alotaibi, Alanoud Aljasham, Wajd Althakfi, Mohamed A Mekhtiche, Abeer Al-Masri","doi":"10.3389/fcvm.2026.1997459","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1997459","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fcvm.2026.1805064.].</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1997459"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of mineralocorticoid receptor antagonists on coronary microcirculation: a mini-review.","authors":"Yu Li, Zhenhong Zhang","doi":"10.3389/fcvm.2026.1855673","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1855673","url":null,"abstract":"<p><p>Mineralocorticoid receptor antagonists (MRAs) serve as a foundational therapies in the management of heart failure, hypertension, and chronic kidney disease. Their primary therapeutic efficacy stems from the competitive antagonism of the mineralocorticoid receptor (MR), which mitigates pathological cascades such as endothelial dysfunction, oxidative stress, chronic inflammation, and perivascular fibrosis. Coronary microvascular dysfunction (CMD)-a pivotal pathological driver across a spectrum of cardiovascular diseases-is defined by impaired vasodilation, heightened microvascular resistance, and diminished coronary flow reserve (CFR). Given that CMD is inextricably linked to dysregulated MR signaling, the restoration of microvascular function represents a key mechanism through which MRAs exert their cardioprotective effects. This review delineates the physiological mechanisms, diagnostic indicators, and generational evolution of MRAs in the context of coronary microcirculation. By synthesizing evidence from animal and clinical studies, this work clarifies the therapeutic utility of MRAs for microvascular protection and provides a comprehensive framework for understanding their pharmacological role in CMD research.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1855673"},"PeriodicalIF":3.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure changes after stair climbing in busy and quiet outpatient clinic environments among Tanzanian adults: a randomised crossover study.","authors":"Issakwisa Habakkuk Mwakyula, Oscar Mahinyila, Thobias Boniphace, Christopher Hariri Mbotwa, Anthony Ambikile Nsojo, Gloria Reginald Mbwile","doi":"10.3389/fcvm.2026.1846924","DOIUrl":"10.3389/fcvm.2026.1846924","url":null,"abstract":"<p><strong>Introduction: </strong>Blood pressure (BP) measured soon after activity may differ from later seated readings. We examined serial BP changes after stair climbing in busy and quiet outpatient settings, without assuming that a particular waiting period represents complete physiological recovery.</p><p><strong>Methods: </strong>In this randomized crossover study at Mbeya Zonal Referral Hospital, Tanzania, adults with and without a previous hypertension diagnosis drew folded numbered slips to determine environmental order. Staff recording BP were not blinded. Participants ascended and descended 19 steps before measurements immediately and every 3 min for 30 min in each environment. Mixed-effects models included period, sequence, age, sex and body mass index, with session-specific random slopes and autoregressive residual correlation. Classification was compared with each participant's environment-specific average at 24, 27 and 30 min. Exploratory laboratory analyses accounted for reporting limits and used the available observations for each marker. Clinical sensitivity analyses examined alcohol, diabetes history and medication classes.</p><p><strong>Results: </strong>The analysis included 443 participants-223 with hypertension and 220 without a previous diagnosis-contributing 9,746 measurement occasions. At 15 min, adjusted busy-minus-quiet systolic BP differences were 2.87 mmHg (95% CI 1.39-4.35) and 4.07 mmHg (2.58-5.56), respectively. Classification disagreement at that time was 10.8% (7.3%-15.5%) in quiet and 7.6% (4.8%-11.9%) in busy settings among participants with hypertension; corresponding values without a previous diagnosis were 2.3% (1.0%-5.2%) and 5.9% (3.5%-9.8%). First-period-only systolic contrasts remained positive but were larger and less precise. Evidence for differences in trajectory shape between diagnostic groups depended on the covariate-adjustment specification. No routine laboratory marker showed a clear adjusted association with the signed SBP difference from the late-session average at 12 or 15 min. Environmental systolic estimates changed little after clinical adjustment within matching samples.</p><p><strong>Conclusions: </strong>BP changed during seated observation after stair climbing, and early readings disagreed more often with the late-session average. Persistent disagreement and within-session variability do not support 12-15 min as a universally sufficient resting interval. The absence of a pre-exercise resting reference and a no-exercise comparator limits attribution of the decline to recovery from activity.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1846924"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Angiography-guided transvenous single-chamber pacemaker implantation in mirror-image dextrocardia with congenitally corrected transposition of the great arteries.","authors":"Junda Cao, Qin Ao, Jin Ma, Ji Sun","doi":"10.3389/fcvm.2026.1956397","DOIUrl":"10.3389/fcvm.2026.1956397","url":null,"abstract":"<p><strong>Background: </strong>Mirror-image dextrocardia with situs inversus is uncommon. Transvenous permanent pacemaker implantation is technically demanding when it coexists with congenitally corrected transposition of the great arteries (ccTGA), because venous access, atrioventricular valve crossing, and fluoroscopic lead orientation may differ from usual anatomy.</p><p><strong>Case presentation: </strong>A 61-year-old man was admitted with recurrent dizziness and palpitations for 5 years; his symptoms had worsened during the preceding 2 weeks. Preoperative 12-lead electrocardiography showed atrial fibrillation with a slow ventricular response. Twenty-four-hour Holter monitoring documented 707 pauses longer than 2.0 s, with a longest R-R interval of 6.13 s. Echocardiography confirmed mirror-image dextrocardia, situs inversus, and ccTGA. A single-chamber permanent pacemaker was implanted through the right axillary vein. Posteroanterior fluoroscopy defined the right-sided cardiac silhouette; right axillary venography guided venous puncture; right atrial angiography identified the morphologic mitral annular plane; and multi-projection fluoroscopy was used to confirm the final ventricular lead position in the high mid-septal region of the morphologic left ventricle. The procedure lasted 56 min and had no acute complications. At 6-month outpatient follow-up, standard 12-lead electrocardiography, 24-hour Holter monitoring, formal device interrogation, and transthoracic echocardiography showed stable pacing, preserved ventricular performance, and no device-related complication; the paced QRS duration was 144 ms and the pacing burden was 99.8%. During telephone follow-up in June 2026, approximately 1 year after implantation, the patient reported no discomfort.</p><p><strong>Conclusion: </strong>This case describes a structured approach to conventional transvenous pacemaker implantation in mirror-image dextrocardia with ccTGA. In this patient, venography, chamber angiography, and targeted fluoroscopic views reduced procedural uncertainty, and follow-up through 1 year showed clinical stability without recognized complications.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1956397"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Pulmonary reperfusion injury with bilateral bronchial cast thrombosis after VA-ECMO-bridged catheter-based reperfusion for cardiac arrest caused by high-risk pulmonary embolism.","authors":"Guanshuai Chen, Fanxiang Chen, Ruoyu Li","doi":"10.3389/fcvm.2026.1970263","DOIUrl":"10.3389/fcvm.2026.1970263","url":null,"abstract":"<p><p>High-risk pulmonary embolism (PE) can lead to acute right ventricular failure, obstructive shock, and cardiac arrest. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides bridging life support, buying time for imaging confirmation and reperfusion. However, reperfusion injury, pulmonary hemorrhage, and airway thrombotic obstruction may follow pulmonary artery reperfusion. Severe airway obstruction caused by bronchial cast thrombi is rare and challenging. We report a woman in her 60s awaiting surgery for a left femoral neck fracture who developed preoperative cardiac arrest due to high-risk PE. After VA-ECMO bridging and staged catheter-based pulmonary reperfusion, the patient developed reperfusion injury and bilateral bronchial cast thrombosis, managed by repeated bronchoscopy with cryoextraction. Electrical impedance tomography (EIT) monitored ventilation and perfusion. The patient was weaned from VA-ECMO and invasive ventilation but remained in a persistent vegetative state due to hypoxic-ischemic encephalopathy. This case suggests that in cardiac arrest caused by high-risk PE, VA-ECMO can buy time for diagnosis and reperfusion; however, reperfusion injury after recanalization can cause severe hemorrhage, with blood coagulating within the airways into bronchial cast thrombi and life-threatening obstruction. Bronchoscopy with cryoextraction effectively clears tenacious airway cast thrombi. EIT assists ventilation/perfusion monitoring during complex VA-ECMO support. Even when cardiopulmonary function recovers, hypoxic-ischemic brain injury may determine long-term prognosis.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1970263"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined assessment of fibrinogen-to-platelet ratio and ApoB/ApoA1 ratio for pre-angiographic risk stratification of severe multivessel coronary disease in NSTEMI.","authors":"Zongqi Zhou, Wei Wang, Haoyu Zhou, Zhiliang Chen, Mingming Jiang, Zimeng Li, Lei Li","doi":"10.3389/fcvm.2026.1931950","DOIUrl":"10.3389/fcvm.2026.1931950","url":null,"abstract":"<p><strong>Background: </strong>Residual inflammation and dysregulated lipid metabolism are closely associated with the extent of severe multivessel coronary disease (MVD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The fibrinogen-to-platelet ratio (FPR) and the apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio reflect these two residual risk pathways, respectively, whereas the clinical value of their combined assessment for pre-angiographic identification of severe MVD remains to be evaluated.</p><p><strong>Objective: </strong>To evaluate the incremental value of combining FPR with the ApoB/ApoA1 ratio for pre-angiographic identification of severe MVD in patients with NSTEMI and to develop an adjunctive risk-stratification model.</p><p><strong>Methods: </strong>This single-center retrospective study included 580 patients with NSTEMI who underwent coronary angiography. Correlation analyses, logistic regression, and restricted cubic spline models were used to assess the associations between the two biomarkers and MVD. The area under the receiver operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the incremental value of the biomarkers. A nomogram was developed and internally validated using bootstrap resampling. Decision curve analysis (DCA) was performed to assess net clinical benefit, and subgroup analyses were conducted.</p><p><strong>Results: </strong>FPR remained independently and positively associated with severe MVD, with an approximately linear dose-response relationship; the association of the ApoB/ApoA1 ratio was attenuated after full adjustment, although it showed complementary value in patients with a very high coronary lesion burden. With the combined model, the AUC increased from 0.683 to 0.719, while the continuous NRI and IDI were 0.488 and 0.037, respectively; adding the ApoB/ApoA1 ratio to the model containing FPR did not significantly improve the AUC (<i>P</i> = 0.266) but yielded further improvements in NRI and IDI. Potential effect modification by diabetes status was observed (<i>P</i> for interaction = 0.025).</p><p><strong>Conclusion: </strong>FPR is an important adjunctive biomarker for the pre-angiographic identification of severe MVD in patients with NSTEMI, whereas the ApoB/ApoA1 ratio provides complementary reclassification information. The nomogram incorporating both biomarkers may facilitate pre-angiographic risk stratification.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1931950"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}